New insights into pneumonia in patients on prolonged mechanical ventilation: need for a new paradigm addressing dysbiosis

摘要

Ventilator-associated pneumonia (VAP) is related to poor outcomes and is most commonly treated with the use of antibiotic therapy in ICUs. The Infectious Diseases Society of America defined VAP as a new lung infiltrate of infectious origin occurring ≥ 48 h after endotracheal intubation.1 Systemic antibiotic use may increase the risk of VAP by depleting commensal microorganisms and selecting gram-negative bacteria that may have multiple mechanisms of resistance. Traditional endotracheal aspirate cultures are unspecific and lead to widespread use of antimicrobial agents. As an alternative to systemic antibiotics, aerosolization has been suggested,2 despite the current lack of evidence of reduction in mortality or in the number of days on mechanical ventilation (MV).3